<div id="titlemerah"><p align="left">Konfirmasi Refund</p></div>
<font color="#bf0d31">*)Pergunakan form di bawah ini untuk melakukan konfirmasi refund tiket anda</font><br>

<div id="blokreg"><br>
    <table>
        <?php if ($this->uri->segment(3) == "gagal"): ?>
            <font color="red"><?php echo "Upload just suport JPG-JPEG-GIF-PNG" ?></font>
        <?php endif ?>
        <?php echo form_open_multipart('deposits/refund_create') ?>

        <tbody>
            <tr>
                <td style="width:200px;">Nama Airlines</td>
                <td><?php echo form_dropdown('id_maskapai', $maskapai, "class='span3'") ?></td>
            </tr>
            <tr>
                <td>Kode Booking</td>
                <td><?php echo form_input('code_booking') ?></td>
            </tr>
            <tr>
                <td>No Tiket</td>
                <td><?php echo form_input('no_tiket') ?></td>
            </tr>
            <tr>
                <td>Route yang direfund</td>
                <td>Asal &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<?php echo form_dropdown('from', $options, "class='span3'"); ?><br /> Tujuan &nbsp;&nbsp;<?php echo form_dropdown('to', $options, "class='span3'"); ?></td>
            </tr>
            <tr>
                <td>Nama Penumpang</td>
                <td><?php echo form_input('nama') ?></td>
            </tr>
            <tr>
                <td>Copy KTP Penumpang</td>
                <td> <input type="file" name="userfile" id="userfile"/></td>
            </tr>
            <tr>
                <td>Keterangan</td>
                <td><?php echo form_textarea('keterangan') ?></td>
            </tr>
           
        </tbody>
    </table><?php echo form_submit('submit', 'Kirim', "class='btn'") ?>
    <?php echo form_close() ?>
    <br /></div>

